Comparing paediatric caudal injection simulation on a 3D-printed, gelatine-cast part-task trainer and the Life/form® Pediatric Caudal Injection Simulator, to real anatomy, by specialist opinion

Abstract

Background: Paediatric caudal anaesthesia is an established technique. Commercially, only one paediatric caudal part-task trainer (PTT) exists. In the South African context, access to caudal block simulation training is lacking. A reusable paediatric caudal anaesthesia trainer was produced through three-dimensional (3D) printing, silicone moulding and gelatine casting. This study compared the local and commercial trainers to patient-based anatomy, by specialist opinion. This was done to validate the locally manufactured PTT for potential anaesthesia training.
Methods: Specialist anaesthesiologists (n = 30) randomly performed a caudal block on each trainer. Visual analogue scales were completed for each PTT, comparing four variables to real patient anatomy (i.e. palpation of bony landmarks and sacral hiatus; simulation of soft tissue; loss of resistance to needle insertion into the epidural space; overall similarity of the experience to caudal injection on a real patient). As a secondary outcome, correct needle placement was confirmed using ultrasound on the 3D-printed trainer.
Results: Bony landmark and sacral hiatus palpation rated a median of 36.50% for the 3D-printed trainer and a mean of 36.58% for the Life/form® trainer (p = 0.28). Soft tissue simulation rated a median of 56.75% for the 3D-printed trainer and a mean of 43.23% for the Life/form® trainer (p = 0.11). Loss of resistance rated a median of 56% and 48.50% for the 3D-printed and Life/form® trainers, respectively (p = 0.44). Overall similarity of the experience to real anatomy rated a median of 52% for the 3D-printed trainer and a mean of 41.97% for the Life/form® trainer (p = 0.23). Simultaneous comparison of all four variables between the two trainers showed no statistically significant difference (p = 0.64). Ultrasound confirmed correct needle placement for 86.67% of participants on the 3D-printed trainer.
Conclusion: The two caudal anaesthesia PTTs demonstrated no significant difference in performance, as judged by specialist opinion. Both models need improvement in terms of fidelity, compared to real anatomy. Using 3D printing to produce PTTs may improve local availability.